January 10, 2013
Is the first week of January turning out as virtuously as you swore to yourself it would eight days ago?
The question I want to pose this week is: should we pay people to lose weight? This idea might seem a little over the top, but studies in the US reveal the surest way to coax people to lose weight is to give them an incentive to do so – and the most persuasive incentive is filthy lucre.
Weight is not just a question of personal vanity, even though most of us feel that way (and those who don’t are not telling the truth). As a result, it is rare to find an honest person who wouldn’t secretly or publically prefer to be a little bit thinner or lighter. When queried about their weight, people tend to cite health reasons for losing a few pounds but in truth, being trim is part of a global aesthetic, which has, for whatever reason, come to dominate what we perceive to be attractive.
More interestingly, subliminal psychological and social judgments can be triggered deep within us when we think about our own weight and that of others.
Leanness has become, in many people’s minds, a type of virtue – a form of statement about the type of person you are. The thin person is self-contained, capable of control, of denial, of going without. This is a person who can govern her own urges. Indeed, in this era of austerity the truly austere person is the trim, lean one.
By extension, the fatter or obese one is considered to be a slob with no self-control. This can and does lead to self-loathing, which psychologists can tell us all about and in the extreme leads to anorexia and other linked illnesses.
Indeed, if you have family members or friends who have difficulty controlling their weight, you will know how debilitating this can be for them physically as well as psychologically. You’ll also know how much of their self worth can be wrapped up in this warped deification of the lean. I have many friends whose daily life is a constant battle with their weight or what they perceive to be chubbiness.
Most of us suffer a bit from this, no matter what size we are (and by the way it doesn’t help that after an excessive Christmas, I am writing this while listening to 1970s David Bowie in his Thin White Duke phase, back when he made Ryan Tubridy look like Mr Blobby).
So it is off to five-a-side soccer for me tonight.
At this time of the year, when we are all full of good intentions, keen to purify ourselves and either look, behave or act differently, it is easy to believe willpower alone can stem the epidemic of obesity threatening our population. But there is little evidence that willpower is enough. This is why something more radical might be entertained, because when we leave the personal we see this is a serious societal and economic issue.
Now let’s look at the economics of this problem in Irish society.
According to the national taskforce on obesity, 61% of Irish adults and 22% of 5-12 year olds are overweight or obese. Men are more likely to be overweight, as are those over 35, and obesity is more prevalent the poorer you are. In one of its more interesting conclusions, the report states:
“The causes of overweight and obesity are characterised as a natural reaction to an unnatural situation. The wide and constant availability of foods, many of which are high in salt, sugar and fat, along with more sedentary work and transport patterns contribute greatly. The term ‘obesogenic environment’ has been coined to describe contexts in which weight gain is passively encouraged”.
The report then tried to put a cost on rising obesity, saying:
“The health and economic impact of this is considerable. Obesity is linked with physical and psychological ill-health and premature death. In Ireland, the costs of related deaths alone have been estimated at â‚¬4 billion per annum”
That’s a huge amount of money. And even if it is an overstatement to make a point, it is worth exploring the consequences of obesity for society as well as the person.
In the US, surveys show that obese people, particularly women, earn less and are more likely to throw sickies. Fascinatingly, other US research has found that obesity in young children negatively affects their verbal, social and motor skills. Obese teenage girls are more likely to smoke and be less active.
The finger of blame in the US, where the problem is most acute and the research more evolved, is pointed squarely at food policy and production. Some research estimates that massive falls in the price of “bad” food such as fatty, corn syrup drenched, high fructose products accounts for 43% of the increase in child obesity. In contrast, the price of fruit and vegetables has risen progressively in America. Profits from producing “bad” foods are then ploughed into advertising, reinforcing the initial health problems.
Controversially, both parents working seems to have negative effects on children’s health; children of working mothers are more likely to be overweight. Interestingly, comparing US states with compulsory PE in school to those that don’t, researchers found compulsory exercise doesn’t materiallyÂ affect obesity rates.
So what to do? It is clear that the present policy is totally irrational.
Imagine trying to reduce smoking by making cigarettes cheaper? This is what we are doing by making “bad” food cheap. This goes against everything we know in economics and how we incentivize people to change behaviour. It’s like urging people to wear seat belts but making cars with seat belts more expensive than those without.
Here is a new notion. Pay people to lose weight. Experiments* in the US show that the best way to help people lose weight is to give them cash. One study took three groups of overweight people. One group was rewarded with cash if they lost weight. The second bunch had to pay to get on a weight loss programme. If they were successful, they got all their money back. The third group received no money, butÂ were praised if they lost weight.
Who lost most, quickest? The people who were paid – of course!
Now I know this sounds truly radical; and paying fat people to lose weight will lead to howls of “moral hazard”Â from trim, self-controlled types. Like many in the debt forgiveness/mortgage relief debate now, they’ll roar that they were virtuous and thin and now they are being punished for it, just like the people without debt argue that they are being punished for being prudent, while free-spenders are rewarded.
But obesity is a societal problem and we will all pay for it. It’s just a matter of which way we choose to pay. At the moment we payÂ through the health bill and taxes, which has had no impact on people’s behaviour. Surely the alternative is smarter?
David McWilliams’ new bookÂ The Good Room is out now.